St. John’s completes first year of participation in Medicare Physician Group Practice demonstration project

While St. John’s participation in the Centers for Medicare and Medicaid Services’ (CMS) Physician Group Practice demonstration project is designed to improve and coordinate care for Medicare patients, it’s actually accomplishing that goal for all St. John’s Clinic patients, whose physicians are participating in the project.

“Designing and implementing a patient registry has been the key to St. John’s first year of participation in this project,” says J.T. Rogers, M.D., St. John’s Clinic internal medicine physician.

“We’re finding that many of our physicians are utilizing the patient registry to track and coordinate all of their patients’ care – not just the Medicare patients. The registry was designed to track the needs of patients with diabetes, congestive heart failure and coronary artery disease for the CMS project, but it’s proven to be a very useful tool for physicians to track all of their patients’ care,” he continues.

As part of the project, St. John’s expanded an already-successful medical management approach to chronic diseases such as diabetes, congestive heart failure, asthma, chronic obstructive pulmonary disease, arthritis and depression, to the Medicare fee-for-service population.

While the deployment of the patient registry has been St. John’s first-year focus, strategies for the second year of the project include developing better coordination of care between health care episodes.

“I use the patient registry for every patient, and have since it was available at St. John’s,” says Sean Tarsney, M.D., a family medicine physician for St. John’s Clinic. “The advantages are that it gives me easy access to each patient’s information. I don’t have to rifle through their chart to find out whether they’ve had a particular test, because our nurses print out each patient’s entry in the registry and place it on top of their chart before their appointment. It’s a time-saver and it allows me to spend more time with my patients,” Dr. Tarsney says.

Nearly 30,000 St. John’s patients are now in the registry and Rogers estimates that CMS will track records on about half those patients.

Another advantage of the patient registry is its ability to track and issue reports on treatment goals met for certain patient populations, such as diabetics, congestive heart failure patients, asthmatics and those with other chronic diseases.

“For example, if a diabetic patient is overdue for their hemoglobin A1c test or hasn’t had their feet examined, the registry will flag that overdue date and it’ll be right there on top of the chart for me to remind the patient to schedule those tests,” Dr. Tarsney says. He adds that 40 percent of his patients are diabetic.

St. John’s Clinic internal medicine physician Heath Morgan, M.D., says the registry allows busy physicians to pay more attention to detail at patient visits.

“Before the registry became available, I was going to create my own patient-care database so I could be better organized and maximize my time at their visits,” Dr. Morgan says. “The tracking ability is a great way to identify patients who are not being compliant with the care they need to manage their condition.”

Dr. Morgan, a self-professed “computer geek,” takes the registry’s functionality a step further. Using a wireless PowerChart, which looks like a clipboard but is actually a computer, he pulls up the patient’s registry entry in the exam room.

“All the data is right there, for the patient and I to go over together. I don’t even have to print it out,” he says.
Chronic conditions account for nearly 70 percent of U.S. deaths and represent more than half of all health care spending, says Janet Pursley, R.N., St. John’s Medical Management Services vice president.

The most common are asthma, diabetes and congestive heart failure. Pursley’s department incorporates strategies such as case management, disease management, utilization management and data management to identify illnesses and coordinate care at a customized level.

“Health care has always been focused on events of care, whether it’s a hospitalization where someone comes in for pneumonia, or whether it’s going to a doctor’s office for advice on how to care for themselves or to get a prescription,” says Walter Gaska, M.D., St. John’s Clinic president.

“By and large, payment systems have been designed around this focus. We have demonstrated that by focusing on chronic conditions, we can keep people healthier and avoid more expensive treatments down the road.”

History

In February 2005, St. John’s Clinic was one of 10 health care organizations selected to participate in the first pay-for-performance initiative for physicians under the national Medicare program.
The project gives physician groups an opportunity to demonstrate that improving care in a proactive and coordinated manner also reduces costs. Currently Medicare reimburses physicians based on the number and complexity of the services provided to patients. St. John’s and other participants in the project will be rewarded by CMS when certain performance targets for chronic-disease patient populations are met.

Evidence is growing that by anticipating patient needs, especially in those patients with chronic diseases, health care teams that partner with patients can intervene before expensive procedures and hospitalizations are required.

“At St. John’s we have been providing care this way for years, often despite economic losses,” explains J.T. Rogers, M.D., St. John’s Clinic internal medicine physician. “We are thrilled Centers for Medicare and Medicaid Services (CMS) is considering alternative reimbursement policies to better support what’s needed to take care of today’s patients.”